Struggling with my body, struggling with my mind

In January, I wrote about my feelings about my weight, and my history of unhealthy relationships with food and dieting. I concluded the post by saying that I was going to focus not on weighing myself, or dieting, but on choosing real (i.e. not junk, or empty calorie) foods and picking exercise activities that I genuinely enjoyed. That approach worked really well – for about 4 weeks. Then somehow I lost the ability to think kindly towards myself or sensibly about my food choices. I ended up buying a whole new set of clothes for my holiday in a bigger size, and returned from the trip towards the end of March with a renewed Coca-Cola habit and “f*ck it” attitude towards what I ate and drank. Fast forward eight weeks. Now many of the clothes I bought in March no longer fit either. Even my partner, who is usually the soul of tact when it comes to my weight, has made cautious mention of the fact that he’s been looking at photos from previous holidays and can really notice the difference in me. I keep thinking of a cliff-top walk I took with my family at Easter, and how for the first time in my life walking up hills had me puffing and panting, to a degree that I could barely enjoy the view. I also keep thinking of how I try very hard not to see myself naked in the mirror these days, or let my partner see me unclothed. Those are new developments, and not welcome ones.

And so I decided that before yesterday’s visit to the psychiatrist, an appointment that would mark one whole year of treatment, I would have to bite the bullet and weigh myself. Before commencing meds, I had been required to get a range of physical health checks done, including basic bloods, blood pressure, and weight/BMI. So my BMI for May 2011 would be in my clinical notes, ready for comparison. I found myself dithering about, talking about all kinds of other topics before I raised the issue of weight; when you’ve been skirting it for months, it’s hard to address head on. At my request, my psychiatrist called up last year’s BMI. There it was: I have gone up 3 BMI points in 12 months, and am heading towards the borderline of overweight and obese. I know that BMI is not uncontroversial and has flaws, but that’s how the NHS took a baseline last year, so that’s how it got measured this year too.

We talked about the causes. Obviously I know it’s not all about the meds, but there’s no escaping that lithium and quetiapine both have known side effects of weight gain. There’s also the fact that I still feel yanked about by my moods. Feel low/tired/brain fogged? Have some chocolate, have a Coke! Feeling high, tunnel vision about a project? Who wants to stop to eat? Boring! Both of these approaches to eating lead to “focus on the now, worry about the consequences later” approach. The low/tired me will do anything for a quick fix and moment’s pleasure, while the high me will leave eating until my body is desperate for fuel, then eat the first thing comes to hand.

What about exercise? My psychiatrist acknowledged how difficult it can be to physically active when you are feeling heavy, sleepy and demotivated. I am still undergoing a constant upwards creep of the quetiapine dosage, something that’s been going on for about six months now. My symptoms, which are general signs of hypomania such as elation and poor sleep, break through. The dose is then increased, and my symptoms are held in check for a while. The downside of this is that I sleep much longer and feel sedated during the day. Then my symptoms arise again, and the does goes up another 50mg. And so on.

I made it clear that I do know what to do to lose weight. I am not stupid. I understand calories in, calories out. About eight years ago, I lost four stones in weight by following the WeightWatchers online programme. But that was under very different conditions. My mood was completely stable on meds of a kind that did not encourage weight gain. I was single, so did not have to struggle as I do now with a partner who gains little weight and continually brings crisps, chocolate, wine and biscuits into the house. I’m at home all day now; back then walked to and from work and went up and down the office stairs all day. It feels like everything is stacked against me now, and I need help.

So what could the NHS offer? Basically, nothing beyond suggestions I have already considered. Yes, it would help me to make a meal plan for the week and stick to it; but if I feel low or very sleepy, constructing a meal plan will be beyond me; if I feel high, I will consider it a boring annoyance. It’s true, I could ask a friend to exercise with me, however most of my day-time friends are elderly and/or physically disabled, and fitting around my working friends means being at home alone all day, then going in the evening just as my partner comes in. Yes, I could rejoin WeightWatchers. £10.95 per month is not an insignificant sum when on benefits, but is at least nowhere near options such as LighterLife, whose weekly charges would wipe out my entire Employment and Support Allowance payment in one fell swoop. And yes, I suppose I could hang on until I’m more stable, and worry about it later.

So it seems that I have two options. I can try and fight against all these competing drug effects and mood fluctuations and see if I can lose weight now. Or I can wait until the drug effects and mood fluctuations have lessened, although nobody knows how long that will take or how much additional weight I will gain while I’m waiting. Either way, any costs incurred from exercise classes, gym membership, or weight loss programmes will be borne by me. Given my ever increasing risk of conditions such as heart disease, diabetes and hypertension, and the fact that my prescribed medications are a significant factor in why I weigh as much as I do, it would make a lot of sense if the NHS could offer a little more support. I know I am not alone. There are thousands of mental health service users out there who feel that they are struggling with their bodies, as well as their minds.

Advertisements

About purplepersuasion

40 something service user, activist, writer and mother living with bipolar disorder. Proud winner of the Mark Hanson Prize for Digital Media at the Mind Media Awards #VMGMindAwards 2013. Winner of the World in Mentalists Mood Disorder blog 2012. Regular guest blogger for the International Bipolar Foundation http://www.internationalbipolarfoundation.org/ Expert by Experience working with Mind training department. Working on The Incoming Tide, a bipolar memoir. Find me on Twitter @BipolarBlogger or at my Facebook page http://www.facebook.com/BipolarBlogger
This entry was posted in Mental health and tagged , , , , , , , , . Bookmark the permalink.

26 Responses to Struggling with my body, struggling with my mind

  1. That sucks. I recognise a lot of what you said in myself too so you have my full sympathy and support. As you’ll know from Mental Health, the NHS only seems able to deal with things once they’ve got to breaking point unfortunately. I wish there were easy answers and preferably an easy fix. Keep yourself strong and do what you can in this fight along with all the others. Right, I’m off to comfort eat now. 😉

  2. Henry Dunn says:

    I reckon the NHS could save a lot money in the long term by offering people whose weight is affected by their medication/mental health free gym membership. Can’t see it happening though!

  3. BB Allen says:

    Part of the reason that the NHS aren’t equipped to assist in this sort of situation is the lack of evidence-based interventions in weight loss – calories in/ calories out is an oversimplification that fails to consider other important factors (like those you’ve listed here) – I also gained weight from medication, but do not diet due to the effect it has on my health (both mental and physical) – for me my wellbeing is more important than my dress size (even if I do end up having to deal with the stigma of being fat as well as having MH problems). However, I didn’t always feel this way and sadly my recovery suffered for it – 7 years ago I decided tro come off my meds (due to weight gain) and suffered a huge relapse MH wise (became v. Depressed – then v. Manic when meds started again). It’s very difficult, especially as the same people who prescribe the pills that cause the gain can be the ones chastising you for it down the line.

    • That’s it, exactly! It’s so complicated – and then you get offered simplistic solutions! Given that they established my BMI last year precisely for this purpose, I kind of feel like – well, that was pointless!

  4. Kit says:

    Hi Charlotte,

    My bodyweight fluctuated madly with quetiapine, mainly because it caused strong lethargy.

    Don’t bother with gyms, they suck. I help out on a mate’s 11 acre smallholding and it beats any sweat and ego-drenched whitewashed £50 a month joint on the planet. You’ll feel just as great pushing wheelbarrows as pumping iron. Plus the proceeds leave your wallet lighter and a better taste in your mouth xx

  5. It’s so frustrating, isn’t it? I’ve been struggling with meds-related weight gain too, and dieting often re-triggers the eating issues I had in my teens. Before Christmas I put on two stone in six months – my weight has stabilised now but I hate my BMI (which has started to be viewed as a problem by health professionals) and the way I look.

    I’m sure you’ve already considered this, but is there any possibility of switching to different meds, or have you already tried the more weight-friendly ones?

    I’m so lucky to be coming off my meds now (with my GP’s / psychiatrist’s approval – in preparation for getting pregnant!) and I hope this will make things easier. It’s not just the increased appetite that was a problem for me, but also the sedation from the meds making it more difficult to exercise and cook from scratch.

    I don’t mean for this comment to sound like an advertisement for coming off meds, though! I know that for many people it simply isn’t an option and it has to come down to weighing the risks against the benefits.

    Thinking of you. x

    • I’m already on quetiapine and lithium. Anti-depressants are a no-go for me as we have spent about a year trying to stop my highs and this whole episode is now almost 2 years long. I did try sodium valproate last year, which went horribly wrong as I had a terrible adverse reaction to it which sent me into crisis. Bascially the only thing which controls my ups and makes me sleep is quetiapine. My psych says he could switch me to a less sedating antipsychotic (olanzapine, or whatever) – the point is if they are less sedating, I will sleep less, which sends me high, which in turn makes me sleep even less. Very Catch-22. So for now, in terms of recovering from this episode and getting back into work, I am stuck with what I have. Not only can I not come off, we are not even sure I’ve reached my maintenance dose yet! So I’m pretty much stuck with it for a while at least :-/

      • JuliesMum says:

        Our experience with olanzapine is that it is caused an awful lot of weight gain – more than quetiapine. Worse, its associated with a strong risk of diabetes – even after allowing for the increase in risk associsted with the weight going up. So it’s not likely to help you much on the weight front.

        I really felt for you, reading this post. Trying to lose weight against the dead weight of medication is like wading through treacle – sticky, slow and demoralising.

      • I don’t really want to switch to olanzapine or another antipsychotic anyway, since my psych doesn’t feel anything else will ensure I sleep through thr night, which the quetiapine is FINALLY doing. Sleep is key for me, so I guess I am stuck with what I’m on!

  6. Suzanne Pickup says:

    I’d like to blame the lithium I take for my weight problems but in reality they started many, many years before I started taking it. My BMI is now 42 but that’s better than it was. Like you I know how to lose weight but struggle when I’m depressed, or constantly tired from trying to hold the depression back. I went as far as getting a gastric band but stupidly didn’t realise my usual comfort foods (chocolate, chocolate cake, chocolate biscuits etc) are completely unrestricted by the band. I try not to worry too much about my weight, I eat healthily when I can and when I don’t I do my best not to beat myself up. It’s not easy and my plan is hugely flawed but I plod on. Personally I’d rather be fat and able to lead even a semi-normal life than be thinner but depressed. My life expectancy is much higher as a drugged up content fat person than depressed thin one!

    • It’s true, I had weight issues before I was on these meds. The big difference for me is that then I was in remission then, so I was able to apply focus and will-power to lose it. Now between my moods and the meds, it’s MUCH harder. But no way would I stop taking the drugs. In fact, I have never even considered it even when thinking through my weight-loss options. I think I’m basically too conformist – my psych always says I am a “compliant patient”!

  7. JuliesMum says:

    Really empathize with this post – it’s obviously not that straight-forward to lose weight or why would so many of us have to wrestle with it? If it was genuinely as simple as calories in – calories out then anyone who can manage to live on benefits would be a whizz at keeping their weight stable. It’s a big extra burden just when you can least do with that burden – and further adds to the stigma of mental illness. Really doesn’t help to get fobbed off with the usual “all you have to do is eat fewer calories than you burn” speech.

    I found being stuck at home all day increased my weight just because I had not much else to focus on other than preparing and eating food. Having something else – almost anything else – to focus on, did help. I also found walking really helped because it was the easiest thing to fit in round other things. I tried one of those pedometer things you can get in Boots and tried to do my 10,000 steps a day.

  8. Pingback: ednosramblings

  9. Lisa Martin says:

    I have suffered excess weight gain but a friend was much worse, gaining 4 stone in 2 months. Never mind the cost of gyms and healthy eating plans, what about the cost of clothes.
    It was costing her a small fortune compared to the benefits she was recieving. Her psych Wasn’t very sympathetic and suggested the problem was black and white i.e. you want to get better or you don’t.

  10. Danni says:

    Once I’d been stable on quetiapine (and trazodone) for a few months I stopped gaining weight, and then very very slowly was able to start losing it (I was doing Slimming World). While your dose isn’t completely settled it may not be the right time. I would just try to eat healthily when you can and try not to beat yourself up if you don’t for whatever reason.

    I was lucky that I’ve recovered enough from depression to have come off both medications, at which point the weight dropped off me so that proved to me it was pretty much all the medication that was causing the weight gain and why I was struggling to lose it. It wasn’t just calories in/calories out for me as I actually increased my calorie intake after I came off the medications as I was losing weight too fast (4-7lbs a week and I was only slightly overweight/top end of normal BMI by that point, and I was unable to exercise at all due to M.E.). I’m now trying to maintain my current weight (11 1/2 stone, with a BMI of about 23) as I don’t think it will do my health any good to try and lose any deliberately at this point.

    I know that coming off medication isn’t usually an option for Bipolar. I wish doctors would help more with the side effects, especially ones like the weight gain. I was blamed by one doctor for being overweight (at my biggest I was 18 1/2 stone, caused by mirtazapine, resperidone and quetiapine at different points) yet I knew as I’d always struggled to keep my weight high enough before starting those medications they were the cause.

    There is the ability to get gym membership or weight watchers/slimming world paid for by the NHS in some areas, but I don’t know how widespread that is. I know for me that when my mental health was unstable, attempting to control my weight at the same time was just something else to beat myself up about so it was a bad idea. Fine when it was stable though.

    This has ended up very long and rambly. Sorry about that 😛

    TL/DR: It’s probably the medication, just try and eat sensibly and try not to worry too much 😛

    • Hi Danni! It’s true that I will have to be on some sort of med forever. Dr has however spoken of taking me off the quetiapine (which I believe to be the real problem) and just leaving me on the lithium – eventually. That is a LONG way in the future however! I’ve made an appt with my GP next week to ask if there is anything funded by the PCT. Thanks for your words of support 🙂

  11. Hi, we’ve been in touch before on twitter, I love your blog, so helpful for “demystifying” bipolar which is vital in developing awareness and reduceing stigma.

    I think I have some simple things that may help and am happy to offer them – if you’re open to that, send me a message and we can take it from there.

  12. Hi there,

    I’ve come across your blog from a link on Mental Health Talk and found this post has really resonated with me.

    I’m Bipolar and have gained over 6 stone since I was first diagnosed. I don’t think it’s really medication causing the weight gain for me, just bad habits! I feel really, really stuck about weight loss. I do want to lose it but I’m really hanging on to my eating behaviours, they’ve become really addictive.

    My mood is relatively stable but I feel pretty hopeless about losing weight. I’m usually a really positive person, but this is one thing that I really don’t seem to be able to become positive about.
    Sorry, don’t mean to have a moan, I didn’t realise I felt like this!

    Your post makes me feel I’m not the only one going through this, so thanks for sharing.

    Rachel

    • Hi Rachel, sorry you are in a similar boat and please fon’t apologise for moaning – it’s a crappy situation! I feel like I’ve been able to take a tiny bit of control back since I wrote the post, but! I’ve been hear before. Will it stick? It’s so hard when all our food shops and adverts are encouraging us to eat the wrong things, while all the windows of wom,en’s clothes shops and all the magazines and clothes adverts tell as we shoule be teeny- tiny! Cx

  13. We’re on the same boat here. I’ve put on 16 kgs in my depression phase and it’s partially due to the quetiapine prescribed by my doctor. I was on 250mg dosage for about year and I would sleep 12-16 hours a day. I’m now on the upswing again and the doctor has cutdown the quetiapine by half so now I’m sleeping only 6 hours a day. Before my long depression phase I was absolutely manic and obssessed about my fitness. I ran everyday and did 10k and half-marathon races. I also cycled and I would start cycling at 4 am and my route was 40k long. I thought I was bloody Lance Armstrong! Anyways Charlotte, there are 2 types of exercises that you can do to lose weight and it’s completely free – walking and jogging. To keep you motivated, get an iPod because it comes with a Nike+ app – you dial in your goal distance, say 3k, and as you walk it will tell you how far you’ve walked and at the end it will congratuate you for reaching your goal! It’s very addictive cause you’ll try to better your goal everytime. Hope this helps.

    • Hmmm, well, the point of my article is that I know all that. I didn’t previously lose the 4 stones by magic, you know! And this time two years ago I was running charity 10ks with the use of the Couch to 10k app for iphone. I have ons of type of exercise I like to do for almost free (if you don’t mind the cost of a DVD) – aerobics, martial arts based workouts, kettlebell, yoga, pilates. My problem is by no means not knowing what to do. The problems are all about finding the motivation and the energy to do it when on high doses of lithium and quetiapine, and when my mood continues to fluctuate. This I why I speak of gyms etc, or maybe actually those outdoor “military fitness” type setups. Walking and running are no help to the person who struggles to find motivation to leave the house and/or get on with things alone.

  14. gogwit says:

    Reblogged this on Gogwit's Blog and commented:
    My long holiday from blogging has been due, in part, to bipolar disorder and the need for medication, in my case Lithium carbonate, which seems to have a demotivating and anhedonic effect on me – as well as the dampening of my manic behaviours both productive and harmful.
    Strip the personal details out of the excellent piece which I am reblogging here; read it and boil it down to the discussion of affect and energy and motivation and volition and self image and dosage.
    What I found was a text that describes well the situation I find myself in at present. I’m pretty sure that this is a template that many with bipolar disorder would recognise.
    The frustration of trying to explain to others:
    “I know what I have to do, step by step, for xyz” but whenever I try to address it – brain fog. As to the NHS: It is such a shame that while I can be prescribed fabulously expensive drugs for weight loss by unnatural means, the option to prescribe gym sessions doesn’t seem to exist.

Leave a Reply

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s